Medical aid: Docs steal R22bn a year

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Cape Town - News that corrupt doctors and other health-care practitioners are defrauding medical aid schemes of as much as R22 billion a year has been met with calls for action – from the DA to Cosatu.

Trade union federation Cosatu said it was “disturbed and shocked” at the report and demanded action against the culprits, while the DA said it would write to the Health Professions Council of SA (HPCSA) to ask it to investigate.

This comes after The Times reported last week that the Board of Healthcare Funders had convened a two-day conference in Joburg to discuss the crisis of soaring medical aid fraud.

Among the reported incidents were:

* A physiotherapist billed for 93 appointments in one day and was caught by the Polmed scheme. She billed another scheme for more than 100 appointments on the same day;

* A doctor billed a scheme for 107 two-hour appointments in a day, which would have meant he worked 214 hours in one day;

* In some cases, doctors supposedly treated patients in Durban, Bloemfontein and Pretoria on the same day.

An analysis of two-and-a-half years worth of data had been done to arrive at the estimated R22bn in fraud. Each member of a medical scheme in South Africa was estimated to be paying between R2 500 and R2 800 a year to cover fraudulent and irregular expenditure.

Cosatu spokesman Patrick Craven said that in line with its policy of zero tolerance of corruption, the federation demanded “tough action against all those proved to have been guilty of such fraud”.

DA health spokeswoman Patricia Kopane said the HPCSA must investigate the reports and “immediately institute disciplinary proceedings”.

It should also work with law enforcement to ensure criminal charges were laid and followed through.

Bertha Peters-Scheepers of the HPCSA said the council was already investigating: “We work closely with the Board of Healthcare Funders and medical schemes and councils when they are investigating matters of fraud.”

craig.dodds@inl.co.za

Political Bureau